妊娠期甲状腺功能异常对妊娠结局及新生儿的影响

Effect of Thyroid Dysfunction During Pregnancy on Pregnancy Outcome and Neonates

目的:探讨妊娠期甲状腺功能异常对妊娠结局及新生儿的影响。方法:选取2018年10月-2019年3月在本院产科门诊进行产前检查并正常分娩的孕妇120例,根据甲状腺功能筛查情况分为甲状腺功能正常组(正常组)81例、甲状腺功能亢进组(甲亢组)22例及甲状腺功能减退组(甲减组)17例。利用电化学免疫发光法对三组血清促甲状腺素(thyroid stimulating hormone,TSH)、血清游离甲状腺素(free thyroxine,FT4)、血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平进行检测并比较。记录并比较三组孕妇妊娠结局、新生儿围生期结局及并发症发生情况。结果:甲亢组的血清TSH水平明显低于甲减组和正常组,而血清FT4和FT3水平明显高于甲减组和正常组(P<0.05)。甲减组血清TSH水平明显高于正常组,而血清FT4和FT3水平明显低于正常组(P<0.05)。甲亢组和甲减组早产率、自然流产率、人工引产率均明显高于正常组,而剖宫产率及自然分娩率均明显低于正常组(P<0.05);甲亢组和甲减组5、10 min新生儿Apgar评分及新生儿出生体重均明显低于正常组(P<0.05);甲亢组和甲减组胎儿宫内生长受限(fetal growth restriction,FGR)、胎儿宫内窘迫(fetal distress,FD)、低出生体质量儿(low birth weight,LBW)、妊娠期糖尿病(gestational diabetes mellitus,GDM)及妊娠期高血压综合征(pregnancy induced hypertension syndrome,PIH)发生率均明显高于正常组(P<0.05);甲亢组与甲减组上述各指标比较,差异均无统计学意义(P>0.05)。结论:妊娠期甲状腺功能异常对孕妇妊娠结局及新生儿预后均可造成不良影响,因此需要加强对妊娠期妇女甲状腺功能的早期干预和筛查,从而明显改善母婴预后。

Objective:To investigate the effects of thyroid dysfunction during pregnancy on pregnancy outcomes and neonates.Method:A total of 120 pregnant women underwent prenatal examination and normal delivery in our obstetrics clinic from October 2018 to March 2019 were selected.According to thyroid function screening,they were divided into 81 cases in the normal thyroid function group(normal group),22 cases in the hyperthyroidism group(hyperthyroidism group)and 17 cases in the hypothyroidism group(hypothyroidism group).The thyroid stimulating hormone(TSH),free thyroxine(FT4)and free triiodothyronine(FT3)in serum of three groups were detected by electrochemiluminescence immunoassay and compared.The pregnancy outcome,neonatal perinatal outcome and complications of the three groups were recorded and compared.Result:The serum TSH levels in the hyperthyroidism group were significantly lower than those in the hypothyroidism group and the normal group,while the serum FT4 and FT3 levels in the hyperthyroidism group were significantly higher than those in the hypothyroidism group and the normal group(P<0.05).The serum TSH levels in the hypothyroidism group were significantly higher than those in the normal group,while the serum FT4 and FT3 levels in the hypothyroidism group were significantly lower than those in the normal group(P<0.05).The premature rate,spontaneous abortion rate and artificial induction rate of the hyperthyroidism group and the hypothyroidism group were significantly higher than those in the normal group,while the cesarean section rate and the natural delivery rate of the hyperthyroidism group and the hypothyroidism group were significantly lower than those in the normal group(P<0.05).The 5, 10 min Apgar scores and neonatal birth weight of the infants in the hyperthyroidism group and the hypothyroidism group were significantly lower than those in the normal group(P<0.05).The incidences of fetal growth restriction(FGR),fetal distress(FD),low birth weight(LBW),gestational diabetes mellitus(GDM)and pregnancy induced hypertension syndrome(PIH)of the hyperthyroidism group and the hypothyroidism group were significantly higher than those in the normal group(P<0.05).However,there was no significant difference in the all above indicators between the hyperthyroidism group and the hypothyroidism group(P>0.05).Conclusion:Gestational thyroid dysfunction can have adverse effects on pregnancy outcome and neonatal prognosis in pregnant women.Therefore,it is necessary to strengthen early intervention and screening of thyroid function in pregnant women to significantly improve maternal and infant prognosis.